Iranian Endodontic Journal
Volume:1 Issue: 1, Spring 2006

Complicated crown- root fractures, extended caries and iatrogenic destruction often result in insufficient sound tooth structures and compromise the biologic width. Two common options for re-establishing flap with osseous surgery. Although some advantages are related to these two options, but coronal movement of gingival and alveolar bone in orthodontic extrusion, esthetic problem and inconsistent topography between the involved tooth and the adjacent teeth following osseous surgery are the involved tooth and the adjacent teeth following osseous surgery are the major disadvantages of these two approaches. The purpose of this investigation was to evaluate clinically as well as radiographically the effect of surgical extrusion upon the surrounding root structures. The material consisted of 21 developed single roots (1 upper and 3 lower) surgically extruded in 17 patients (15 male and 2 female mean age 26 years, ranging 10-40). The indication for surgical extrusion was in 15 cases complicated crown root fracture and in 6 cases early loss of the crown due to an extensive decay. The roots were used where there were completed root developments and the apical fragments were long enough to accommodate a post retained crown. Preoperative radiograph as well as photograph was taken and the clinical and radiographic findings were monitored. The roots were transplanted in their socket in order to reestablish the biologic width. Fixation was carried out with a suture splint and/ or periodontal dressing for 7 days. Recall radiographs were taken at 1 and 4 weeks and at 3 month internals over a 12- month period. Clinically none of the material of 21 teeth demonstrated ankylosis, abnormal mobility and sensibility to percussion or palpation radiographically, PDL healing at 12- month follow up was found in 20 teeth (95.2%). successful results up to the time of evaluation encouraged further use of surgical extrusion. Long term evaluation is recommended.

Acute pain and swelling following endodontic treatment are challenges for patients and dentists. According to previous studies، the incidence of flare-ups increases after endodontic treatment of teeth with necrotic pulp. Calcium hydroxide is currently used as a multipotential medicament in root canal therapy. The aim of this study was to evaluate the incidence and severity of flare-ups after treatment of pulpless teeth using calcium hydroxide as an intracanal dressing. Sixty patients with single root necrotic teeth participated in this study. These patients were randomly divided into three groups of twenty. The patients in group A were treated in a single-visit approach، in group B with a two-visit approach without any intracanal dressing and in group C with a two-visit approach using calcium hydroxide as an intracanal dressing for one week. All of the patients were followed for 72 h after each treatment session. The information about the incidence and severity of pain and swelling was recorded in tables، using a modified visual analogue scale for pain severity measurement and a scale with four degree for measuring the severity of swelling. The data were analyzed by chi-square test and GENMODE procedure. The incidence of pain showed to be the highest in group B and the lowest in group C. These differences were statistically significant. There was no significant difference in the severity of pain after the first visit between groups B and C; however، the severity of pain was significantly lower in group C after the second visit. The incidence of pain in group C was significantly lower than that in group A، but there was no significant difference in the severity of pain between these two groups. There was no significant difference in the incidence and severity of swelling among the three groups. It is concluded that calcium hydroxide as an intracanal dressing could be effective to decrease the postoperative pain and swelling. Therefore it is recommended to use calcium hydroxide as an interappointment dressing in necrotic teeth.

The ideal endodontic treatment for the teeth with in complete root-ends and necrotic pulps may involve the use of material which forms an immediate apical barrier instead of long term calcium hydroxide therapy. Such procedure may lead us to a single appointment endodontic treatment. The purpose of the present study was to evaluate clinical and radiographic success rate in necrotic teeth with open apices treated with MTA as an apical plug. Thirty five patients between the ages of 8-16 with total number of 41 necrotic anterior teeth containing open apices were selected. In the first visit، root canals were debrided and filled with calcium hydroxide. After one week، calcium hydroxide was removed and MTA with the thickness of 3 to 4 mm was put in the apical region of the canals. After 24 hours، the remaining part of the canals was filled with guttapercha and sealer and the teeth were restored with composite. All the cases were evaluated clinically and radiographically after 3 and 6 months and data were analyzed by McNemar test. No clinical symptoms were observed in 97. 6% of the teeth after 3 months and in none after 6 months. The study showed a significant difference from pretreatment status. After 3 months radiographic evaluation showed that in 17 cases (41. 5%)، lesions were reduced and in 14 cases (34. 1 %)، lesions remained the same، and in 10 cases (24. 4%) lesions disappeared. After 6 months in 21 cases (51. 2%)، lesions were reduced، in 3 cases (7. 3%) lesions remained the same and in 17 cases (41. 5%) lesions disappeared. These finding were statistically different from pretreatment data. The results indicate that MTA can be used as an apical plug in the teeth with open apices following root canal debridement and disinfection with calcium hydroxide. Further investigations with longer follow-ups are recommended in order to evaluate the effect of this material.

Failure to achieve adequate and profound anesthesia in teeth with acute pulp inflammation is a common condition during emergency visits in root canal therapy. Many different anesthetic solutions such as morphine and capsaicin have accordingly been examined. Mannitol­ an alcoholic sugar with high osmotic pressure level- is applicated for reducing intracranial and post retinal pressure in medicine. It has also been used for its diuretic effect. In combination with local anesthetic solution، it increases permeability of the nerve fiber sheath and leads to influx of the local anesthetic through cytoplasmic membrane. The purpose of the present study was to compare the efficacy of routine local anesthesia with or without using mannitol in teeth with inflamed pulps. one hundred patients with acute dental pain in posterior teeth were selected. Vials with 3 ml anesthetic solution containing 2. 5% lidocaine with 1/80000 epinephrine or 2. 5% lidocaine with 1/80000 epinephrine and 0. 5 mol mannitol were used for anesthesia. For each patient، the routine injection technique was applied، during the removal of decay and dentine. Depth of anesthesia was evaluated and the supplementary injection was done in case of pain feeling and then pulpotomy was done. The analysis of data was done using chi-square statistical test. The results showed that complete anesthesia after the first injection was obtained with lidocaine mannitol in 46% and with lidocaine alone in 38% of cases. However، the difference was not significant. These finding suggest that the addition of mannitol to the standard anesthetic solution could insignificantly increase the level of anesthesia in teeth with inflamed pulps.

This study was carried out to investigate calcific tissue formation against mineral trioxide aggregate (MTA) after pulp capping. The pulps of six teeth from four dogs were exposed and capped with MTA. After extraction each tooth was sectioned into halves. Each half was then further sectioned in the mesiodistal or buccolingual direction. Calcified tissue of the capped area was examined from either the pulpal side or in profile view using scanning electron microscopy and focused ion beam imaging. The results from all views showed that MTA crystals were in direct contact with calcified tissue. Calcified bridges after focused ion beam preparation showed the same pattern that were seen by scanning electron microscopy in profile view. Newly deposited dentine and early phase of calcosphirit structures could clearly be distinguished from older tubular dentine. MTA when used as a pulp capping agent could produce calcific tissue in underlying pulp.

Success in endodontic treatment depends on various factors. Among the most important factors, appropriate preparation of the root canal system and keeping periapical region intact as much as possible could be mentioned. These are achieved by determining the penetration depth of the instruments into the canal i.e. the working length. Several methods are introduced for working length determination. The most popular techniques in this regard are the use of conventional radiography and electronic apex locators. A new type of apex locator is the Root ZX. The purpose of this study was to compare the accuracy rate of Root ZX apex locator with the conventional radiography. The working length of thirty extracted single rooted teeth were determined by the means of the Root ZX and conventional radiography then compared with the actual working lengths measured by the stereomicroscope. The results showed there was statistically significant difference between the length determined by the Root ZX and stereomicroscope. In addition, the radiographic and stereomicroscopic working lengths had statistically significant differences as well. There was also significant difference between the lengths measured by the Root ZX and radiography. It is recommended to use the Root ZX and radiography both together to reach the most accurate working length.

Traumatic injuries to the teeth are among the most serious dental accidents، with the anterior teeth being mostly affected. Some consequences of dental trauma include misshaping، speech defects، psychological and social effects. The knowledge of the field can reduce the suffering، cost، and the time for patients، parents، and health care providers. The aim of this study was to investigate the treatment prognosis of anterior traumatized teeth in patients referred to Endodontics and pediatrics Departments of Shahid Behesthi and Tehran Dental Schools during 1996-2001. Fifty patients participated in this descriptive study. All affected by trauma to the teeth and completing the proposed treatment. Retrospective data، based on trauma forms as well as the clinical notes a questionnaire prepared for the study and analyzed in terms of age، gender، the type of trauma and etiology. Eighty four percent of the studied traumatized teeth were maxillary centrals. Falling-outs are most frequent cause of the traumas (56. 5%)، followed by sport and play events (30. 4%). Enamel- dentin fractures with and without pulpal involvement were the most prevalent trauma types. Most of the selected treatment procedures were involved with pulp and periapical areas. Based on the finding of the study، the prognosis of traumatized anterior teeth in patients referred to the studied centers was estimated to be good.

This article describes a clinical case of mandibular second premolar with three separated canals in apical third of the root that are diagnosed and endodontically treated. Sound knowledge of root canal anatomy and morphology، tactile examination of canal walls، critical interpretation of radiographs and high magnification examination are essential elements of success in complicated root canal therapy.